Every time I meet a woman who
smokes I ask if she uses the pill or HRT. If she does, I say you're
going to get breast cancer.

It won't be today. It won't be tomorrow. Maybe not even for the first five years, unless you smoke. But cancer is coming.

Estrogen was added to the list of carcinogens for a reason, you know.

Just try to get pharmaceutical
companies to give you the odds on breast cancer after five years on the
pill and HRT. How about the numbers of young women getting cancer in
their twenties after ten years on the pill. Same with older women after
ten years on HRT. Then add smoking to the mix.

Needless to say, I don't get many
phone calls that start out, "Hey guess what, you know when you warned
me about the dangers of smoking and taking estrogen products, well you
were right!"

I hear about it through the
grapevine. And I no longer call or send flowers or a basket because I
was the messenger and they'd all like to kill me.

But that isn't what my rant is
about. My rantis about how doctors mutilate women's breasts when they
operate. And it isn't necessary.

In 1964 -- the date is important --
my mother, who was a nurse, had a radical mastectomy the day before a
tennis tournament she was playing in was due to start. She found a lump
and was operated on the very next day by a top plastic surgeon at the
University of Chicago.

She went into surgery not knowing
what the outcome would be. Breast or no breast? Cancer or no cancer?
You didn't know until you woke up.

They found cancer that had
metastasized. She lost her entire breast, a great deal of her lymph
nodes and a chunk of muscle. Despite the fact that she had started
smoking again, she had trained for months for the tournament. That's
why two weeks later I was on the court hitting balls with her, even
though she still had a drain in her arm.

Here's my point. The incision was
huge. It went from under her armpit in a semi circle down her chest and
around to her back down by her waist. But the scar was almost
invisible. You couldn't see it unless you looked very closely. Plastic
surgeons are competent that way.

The muscle had been dissected with
the skill of a sculptor, so there was no gross distortion where it had
been removed. Looking at her chest you couldn't tell there had ever
been a breast there because the area was so smooth. In fact, I couldn't
tell there had ever been surgery. She could look at herself in the
mirror without disgust or self loathing. Unfortunately I thought this
was the standard of surgery every woman could expect.

Keep in mind this was four decades ago.

As recently as two years ago, I've
seen and heardegregious examples of female mutilation by surgeons who
consider themselves experts in breast removal and reconstruction.

I've seen simple mastectomies that
left women with a huge scar that looks like a railroad track from one
side of the breast to the other. And the breast looks like a deflated
fleshy balloon.

What the fuck are doctors thinking?
That a woman would rather have a saggy slab of skin with a five
to seven inch horizontal red zipper in place of her nipple, instead of
having the breast completely excised and repaired with artful
subcutaneous stitching so the evidence of removal and disease is gone?

General surgeons have no business repairing women's breasts. Period.

Breast surgeons should all be board certified in plastic surgery. Or they should not be breast surgeons.

Reconstruction is a joke, too. You
can end up with an implant floating up near your shoulder. It happened
to someone close to me. And mismatching is a huge problem.

Not to mention that the scars don't usually go away. And they have to tattoo a nipple for you.

Which leads me to a question.
Plastic surgeons have finally figured out a way to spare the nerves
leading to the nipples so that sensitivity can be retained when they
perform breast augmentation. Maybe there were so many complaints that
they stopped snipping haphazardly and learned to be more careful.

So why can't the nipple be spared
the same way when there's cancer? Why does it automatically come off?
Is it too much trouble for the doctor to operate in a way that would
leave a woman with the one part of her breast that can contribute to
HER satisfaction?

A friend of mine was diagnosed with
metastasized breast cancer at 36. She had both breasts removed. Her
breasts had been so beautfiul they should have been in a museum
somewhere.

Afterward she showed me the
reconstruction. Her combination saline/silicone implants were an odd
shape. They looked like a bad execution of a great concept. And the
nipple tattoos were a joke.

And there were these dark lines
under each breast where the scars were. The area was smooth but
discolored. Do doctors think that any kind of breast is better than
none at all?

She has since had the implants
removed and is much happier. Her husband seems okay with it too. I
haven't seen what her breast free chest looks like so I don't know what
kind of scars she has now. The good news is that she is a 25-year
survivor.

There is an infamous photo of
several women with their disfigured breasts exposed, which is so awful,
it makes you look away in horror. I have been trying to find it. The
ugliness is completely unnecessary. That kind of scarring ought to be
grounds for malprarctice.

That photo or one like it was
featured by Rosie O'Donnell in her now defunct magazine Rosie, I
believe. Her mother also died of breast cancer.

On the other hand, I have also seen
a very natural looking reconstruction on a thirty-two year old woman,
based on her appearance in a bikini, where the artificial breast with
the implant was beautifully matched with its partner. Here again it
took more than one try to get the breasts to match, including adding an
implant behind the healthy breast.

Given a choice after seeing what I'veseen, I know what I would do. But first, there are some things I've already done.

I nursed my babies, because breastfeeding seems to provide some kind of protection -- at least statistically. There have been theories about the
release of melatonin and its preventative benefits, but I don't think
anything has been proven conclusively.

I have never smoked. I took the pill, but only for three months in my twenties. I have never taken HRT.

Another contributing factor to
cancer may include exposure to pesticides used in gardening, which
convert to estrogen compounds in the body. My mother was an avid
gardener who cleaned out her pesticide spray can by hand each time she
used it.

Also there is a theory about the
effect of magnetic fields created by electric blankets over a prolonged
period of time. My mother slept under an electric blanket, too.

If ever diagnosed with breast
cancer, I would hire a plastic surgeon to operate
and remove the breast. Even if the cancer is in situ -- in place -- and hasn't spread. Lumpectomy and chemo is usually an
option then. No thanks. I won't get into the damage chemo can cause to your
heart and other organs. You need to be young to withstand that kind of
poison.

I would also ask to see photographs
of the surgeon's prior results, before any reconstruction. Show me how
good you are, Doc. I want the smooth scar free result my mother had.

I do not want reconstruction. Would you tear down a national landmark to put up a trailer park?

And I wouldn't wear what I call a
Porta-breast -- a bra with a prosthesis inside. Less is more when one
is older. Besides breasts just get in the way playing sports.

When my mother was my age she had
been dead for almost twelve years. So far, my tobacco free, estrogen
free lifestyle seems to be working. My mammograms have been okay.

Ironically, however, after being so careful about my breast health all
these years, I realize now that I have risks for other cancers and
diseases that weren't even on my radar.

18 comments:

shaz19743
said...

Im awaiting the rest of this with interest Mrs L , lost my grandmother to BC 16 years ago when the treatment and surgery was even worse than it is now so i have a real bug up my butt about this issue for want of a more eloquent way to describe my frustration on the matter x

I agree. I went against the advise of all my doctors and refused HRT's. My skin dosn't have the wonderful look or elasticity that it once did, but I don't care. I am also very cautious about shaving and deorderant. Lung cancer is women is so prevelent today, catching up to breast cancer. Anne

I totally agree. I saw what they did to my sister, who was diagnosed with breast cancer at the age of 39. It's one of the reasons I won't go to a doctor. Another reason is that doctors killed my father who went into the hospital for a simple procedure and ended up dead. The third reason is that both of my brothers are doctors and they convinced my mother not to sue the hospital, because they didn't want to have to testify against their own collegues. Absolutely disgusting.I have no faith in doctors whatsoever.Maryanne

My cousin is battling breast cancer and it has metastasized. I am mad as hell at the doctor who did not do the proper blood work on schedule. She now has to go through a more aggressive treatment. I'm waiting to read your next installment on this subject.

You have a right to be angry about the mutilation of a radical mastectomy. When I first became a nurse that was the only treatment. Such a horrifying end result. They removed all muscle and connective tissue in addtion to the breast, so you had unimaginable scarring and impaired movement. Plus they always removed all the lymph nodes from around the arm and shoulder, leaving the woman with a grossly swollen and deformed arm on the affected side because the body fluids could not normally drain or be reabsorbed. It was tragic. Over the past 30 years I have witnessed terrific strides. We now know, when there has not been extensive metastasis, a minimally scarring lumpectomy is just as effective. Newer, kinder, more effective drugs has also helped the cause. I also believe that the increased number of female physicians in the medical field has helped with better treatment.

I don't see this as a rant at all. Your tender caring for these women comes through even more strongly than your anger at the incompetent surgeons. I told my most heartbrking breast cancer story last October. I sure do miss Eileen.

very good post. My Dear Aunt Mickey died of breast cancer, and she was a smoker as well. Thank you for writing this piece. judips so you have never had HRT? I have been wondering what to do about that when the time comes..... I have always been against putting anything like that into my body.

I'm sorry about your mother. I lost my mother to breast cancer in 1986 and a sister to breast cancer in 1973 (she was just 36). It's a horrible disease (not that there are any good diseases) and I agree with you that general surgeons have no business repairing women's breasts.

I think you are right. Smoking is some kind of catalyst that just moves things into place when combined with estrogen.

My Nana was quite the smoker, back in the day. She had to have a breast removed, gosh, it's been more than 15 years ago. Her scar used to scare me, when I'd help her in the bath. It's the size, width-wise that her breast used to be, but smooth, and discolored. But her chest seems hollow there, probably due to loss of muscle. She didn't want reconstruction, because at her age, she said, she wasn't planning on getting any action. Fine, it's her choice, I told myself. I couldn't understand why, knowing she wasn't opting for it, her doctor couldn't have done a better job and not left her a lumpy hollow, a cliff where her breast used to be.Now, I'm not afraid to look at her scar anymore. To me, it's just a landmark, of a battle that she won. She's 91 now.

Unfortunately, Mr W's Mom didn't win. She was a great lady, and I was barely getting to really know her when she passed away. She used a plastic surgeon for the reconstruction, and I remember she was pleased with the result. She accepted it as the price for living, though, I think.

It's not right that you have to choose between disfigurement via scarring or disfigurement via reconstruction. With all the advances in surgery today, no one should have to pay a price for living. I'm sure the insurance companies see it differently, though. Anna

I'm sorry to hear of the loss of your mother to breast cancer. This is a passionate issue for me. My identical twin sister, Julie, was first diagnosed with it at age 31 and again at age 39. She never smoked or took birth control pills. She jogged 6 miles a day, breast fed her child, and never lived around power lines. Picture of health, I tell you. Then, BAM!...breast cancer at age 31. There are lots of theories about why we get cancers, and you've touched on valid ones. However, just because someone has cancer doesn't mean they did something wrong. About reconstruction versus not, well, that's a personal decision that only an informed patient can make. There's a lot of competent doctors doing fabulous work, and it takes investigation to find the best doctors.I'm sad you found the photograph awful {offensive(?)}. The photographer's name is Jean Karotkin and the photograph represents something beyond physical. It represents the courage and beauty of breast cancer survivors. Jean Karotkin has a book out, it's titled "Body & Soul" and it's beautiful. The photographs, stories, and people are beautiful. The author/photographer is a breast cancer survivor herself.My twin and I are one of the subjects in the book.Judithhttp://journals.aol.com/jtuwliens/MirrorMirrorontheWall

I'm sorry you lost your mother so many years ago, I can only imagine the grief you are still enduring.Although you bring up a few interesting interpretations of how one "contracts" breast cancer, I have to concur with my twin sister, Judith. I NEVER smoked, breast fed my child (8 months), jogged 6+ miles for years, HATE gardening, NEVER lived around power lines, had a low fat/high fiber diet, NEVER had an electric blanket, rarely drank alcohol, never dyed my hair and NEVER took the pill. The last thing I (and everyone) expected is that I would get breast cancer, especially at the age of 31 (1997) and again at 39 (2005). I ask you.... why did I get breast cancer???I am proud of my 'team' of doctors, oncologists, nurses, radiologist, general surgeon, reconstruction surgeon, lab tech's, phlebotomists, genetic specialist and everyone that has had a hand in "tearing me down and rebuilding me". It is people like you that vomit words that are not only stupid, but ignorant and naive, without knowing of each woman's choices in treatment: lumpectomy/mastectomy/reconstruction/chemotherapy/HRT and other facts of our current day medical system. If you want to talk about BREASTS... talk about your own, not YOUR interpretation of how/why doctors mutilate women's breasts, and the choices one makes with her body.naive = lacking worldliness, sophistication and understanding.stupid = Slow to learn or understand; obtuse.ignorance = The condition of being uneducated, unaware, or uninformed.Oh, you can find Judith & I on page 74-75 of our dear friend, Jean Karotkin's book http://www.jeankarotkin.com/ if your not offended by proud, strong and confident women and men. - Julie - http://journals.aol.com/jtuwliens/MirrorMirrorontheWall

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I like quiet evenings by the artificial log fire, walks on the beach [but not Daytona, because that sand is like walking on cement], the scent of lighter fluid right after the match hits the charcoal, the sound of a hog idling in my driveway, you know, the simple things.